Korean J Nephrol.  2010 Sep;29(5):585-592.

Vancomycin Pharmacokinetics in Oliguric Patients Undergoing Continuous Venovenous Hemodialysis and Continuous Venovenous Hemodiafiltration

• Park I
• Lee SA
• Lim SK
• Yu S
• Jang EJ
• Moon EJ
• Hwang JA
• Kim H
• Shin GT

Abstract

PURPOSE
Critically ill patients receiving continuous renal replacement therapy are susceptible to infection with methicillin-resistant bacteria, which require treatment with vancomycin. However, there are limited reports regarding vancomycin pharmacokinetics in the continuous venovenous hemodialysis (CVVHD) and continuous venovenous hemodiafiltration (CVVHDF). We performed this study to investigate the pharmacokinetics of vancomycin in oliguric patients receiving CVVHD and CVVHDF.
METHODS
Data at steady-state obtained as part of our routine drug monitoring of vancomycin therapy in critically ill adult oliguric patients undergoing CVVHD or CVVHDF, retrospectively. Data were available for 35 cases of 23 patients assessed for 2 years. We analyzed the pharmacokinetic parameters of these cases.
RESULTS
8 cases on CVVHD and 27 cases on CVVHDF were available. The mean intensity of CVVHD was 17.7+/-4.9 mL/hour/kg and that of CVVHDF was 32.1+/-3.9 mL/hour/kg (p=0.000). The mean clearance of vancomycin was 16.4+/-3.8 mL/min in the CVVHD group and 21.6+/-5.1 mL/min in the CVVHDF group (P=0.007). The elimination of vancomycin correlated with the intensity of CVVHD and CVVHDF (CVVHD; r2=0.745, p=0.012, CVVHDF; r2=0.452, p=0.000).
CONCLUSION
CVVHD and CVVHDF are effective for vancomycin elimination and there is a strong dependency of the vancomycin removal on the intensity of continuous renal replacement therapy. Strategies for individualization of vancomycin therapy in patients receiving CVVHD and CVVHDF are proposed.

Keyword

Vancomycin; Pharmacokinetics; Renal replacement therapy

MeSH Terms

Adult
Bacteria
Critical Illness
Dependency (Psychology)
Drug Monitoring
Hemodiafiltration
Humans
Methicillin Resistance
Renal Dialysis
Renal Replacement Therapy
Retrospective Studies
Vancomycin
Vancomycin